Dynamics of Prescribing Antithrombotic Therapy to Patients with Atrial Fibrillation Hospitalized for Myocardial Infarction in 2016–2021

Abstract

INTRODUCTION: At present, the issue of optimal antithrombotic therapy (ATT) in patients with myocardial infarction (MI) and atrial fibrillation (AF) has not been finally resolved, it requires an individual approach and is of interest for study.

AIM: To study the dynamics of prescribing ATT to patients with AF of non-valvular etiology hospitalized in cardiology hospital in 2016–2021 for MI.

MATERIALS AND METHODS: The study included 599 patients with MI and AF: in 2016–2017 — 104 patients, in 2018–2019 — 256 patients, in 2020–2021 — 239 patients. The median and interquartile range of age of patients hospitalized in 2016–2017 were 70 (61.0; 78.0) years, in 2018–2019 — 71 (65.0; 79.3) years, in 2020–2021 — 72 (65.0; 80.0) years, p = 0.09.

RESULTS: In 2016–2017, 76.9% of patients with MI and AF were prescribed double antiplatelet therapy (DAPT) from the first day of hospitalization; 16.3% of patients were prescribed therapy with oral anticoagulants (OACs), here, in 6.7% — as part of triple ATT, in 8.7% — as part of double ATT (OACs + antiplatelet agent), in 1.0% — as monotherapy with OACs; in 3.8% monotherapy with an antiplatelet agent was prescribed; in 2.9% of cases ATT was not prescribed. In 2018–2019, DAPT was used in 37.9% of cases; therapy with OACs — in 54.7% of cases: in 44.9% cases as part of triple ATT, in 9.8% as part of double therapy; in 7.4% of cases monotherapy with antiplatelet agent was prescribed. In 2020–2021, DAPT was prescribed in 15.9% of cases; therapy with OACs in 74.5%, of them in 59.8% — triple АТТ, in 14.2% — double АТТ; monotherapy with an antiplatelet agent - in 7.5%; in 1.7% АТТ was not prescribed.

CONCLUSION: In the study, the frequency of prescription of triple ATT to patients with AF and MI in 2020–2021 increased 1.3 times as compared to 2018–2019, and 8.9 times as compared to 2016–2017 and made 59.8% (p < 0.001 for all periods). The frequency of OAC also increased 1.3 times as compared to 2018–2019 and 4.6 times as compared to 2016–2017 and made 74.5% (p < 0.001 for all periods). This dynamics of increase in the frequency of prescription of oral anticoagulants to patients with a combination of AF and MI should be considered a positive result of introduction of the Clinical recommendations in the treatment of cardiologic patients.

Keywords

atrial fibrillation / myocardial infarction / antithrombotic therapy / oral anticoagulants / warfarin / rivaroxaban / HAS-BLED / CHA2DS2-VASc

References

[1] Violi F, Soliman EZ, Pignatelli P, et al. Atrial Fibrillation and Myocardial Infarction: A Systematic Review and Appraisal of Pathophysiologic Mechanisms. J Am Heart Assoc. 2016;5(5):e003347. doi: 10.1161/JAHA.116.003347

[2] Violi F., Soliman E.Z., Pignatelli P., et al. Atrial Fibrillation and Myocardial Infarction: A Systematic Review and Appraisal of Pathophysiologic Mechanisms // J. Am. Heart Assoc. 2016. Vol. 5, No. 5. P. e003347. doi: 10.1161/JAHA.116.003347

[3] Jabre P, Roger VL, Murad MH, et al. Mortality associated with atrial fibrillation in patients with myocardial infarction: a systematic review and meta-analysis. Circulation. 2011;123(15):1587–93. doi: 10.1161/CIRCULATIONAHA.110.986661

[4] Jabre P., Roger V.L., Murad M.H., et al. Mortality associated with atrial fibrillation in patients with myocardial infarction: a systematic review and meta-analysis // Circulation. 2011. Vol. 123, No. 15. P. 1587–1593. doi: 10.1161/CIRCULATIONAHA.110.986661

[5] Belkouche A, Yao H, Putot A, et al. The Multifaceted Interplay between Atrial Fibrillation and Myocardial Infarction: A Review. J Clin Med. 2021;10(2):198. doi: 10.3390/jcm10020198

[6] Belkouche A., Yao H., Putot A., et al. The Multifaceted Interplay between Atrial Fibrillation and Myocardial Infarction: A Review // J. Clin. Med. 2021. Vol. 10, No. 2. P. 198. doi: 10.3390/jcm10020198

[7] Parshikova EN, Filippov EV. Mortality from all causes in patients with myocardial infarction with elevation of ST segment depending on the type of reperfusion therapy (data of Ryazan region, 2018–2020). I. P. Pavlov Russian Medical Biological Herald. 2020;28(4):479–87. (In Russ). doi: 10.23888/PAVLOVJ2020284479-487

[8] Паршикова Е.Н., Филиппов Е.В. Смертность от всех причин у пациентов с инфарктом миокарда с подъемом сегмента ST в зависимости от типа реперфузионной терапии (данные Рязанской области, 2018–2020 гг.) // Российский медико-биологический вестник имени академика И. П. Павлова. 2020. Т. 28, № 4. С. 479–487. doi: 10.23888/PAVLOVJ2020284479-487

[9] Kirchhof P, Benussi S, Kotecha D, et al. 2016 ESC guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Russian Journal of Cardiology. 2017;(7):7–86. (In Russ). doi: 10.15829/1560-4071-2017-7-7-86

[10] Kirchhof P., Benussi S., Kotecha D., et al. Рекомендации ESC по лечению пациентов с фибрилляцией предсердий, разработанные совместно с EACTS // Российский кардиологический журнал. 2017. № 7. С. 7–86. doi: 10.15829/1560-4071-2017-7-7-86

[11] Hindricks G, Potpara T, Dagres N, et al. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS). Russian Journal of Cardiology. 2021;26(9):4701. (In Russ). doi: 10.15829/1560-4071-2021-4701

[12] Hindricks G., Potpara T., Dagres N., et al. Рекомендации ESC 2020 по диагностике и лечению пациентов с фибрилляцией предсердий, разработанные совместно с европейской ассоциацией кардиоторакальной хирургии (EACTS) // Российский кардиологический журнал. 2021. Т. 26, № 9. С. 4701. doi: 10.15829/1560-4071-2021-4701

[13] Pereverzeva KG, Yakushin SS, Pripadcheva AE, et al. Antithrombotic Therapy in Patients with Atrial Fibrillation after Myocardial Infarction: Clinical Guidelines and Actual Practice. Rational Pharmacotherapy in Cardiology. 2018;14(6):858–63. (In Russ). doi: 10.20996/1819-6446-2018-14-6-858-863

[14] Переверзева К.Г., Якушин С.С., Припадчева А.Э., и др. Антитромботическая терапия у пациентов с фибрилляцией предсердий после инфаркта миокарда: клинические рекомендации и реальная практика // Рациональная Фармакотерапия в Кардиологии. 2018. Т. 14, № 6. С. 858–863. doi: 10.20996/1819-6446-2018-14-6-858-863

[15] Pereverzeva KG, Yakushin SS, Yakushina MS, et al. Changes in prescribing antithrombotic therapy in patients with atrial fibrillation and myocardial infarction in 2016–2019. Russian Journal of Cardiology. 2020;25(7):3908. (In Russ). doi: 10.15829/1560-4071-2020-3908

[16] Переверзева К.Г., Якушин С.С., Ежова А.В., и др. Динамика назначения антитромботической терапии у пациентов с фибрилляцией предсердий и инфарктом миокарда в 2016–2019 гг. // Российский кардиологический журнал. 2020. Т. 25, № 7. С. 3908. doi: 10.15829/1560-4071-2020-3908

[17] Loukianov MM, Martsevich SYu, Yakushin SS, et al. The control of international normalised ratio in patients with atrial fibrillation treated with warfarin in outpatient and hospital settings: data from RECVASA registries. Rational Pharmacotherapy in Cardiology. 2018;14(1):40–6. (In Russ). doi: 10.20996/1819-6446-2018-14-1-40-46

[18] Лукьянов М.М., Марцевич С.Ю., Якушин С.С., и др. Контроль показателя международного нормализованного отношения на фоне терапии варфарином у больных с фибрилляцией предсердий в амбулаторной и госпитальной практике (данные регистров РЕКВАЗА) // Рациональная фармакотерапия в кардиологии. 2018. Т. 14, № 1. С. 40–46. doi: 10.20996/1819-6446-2018-14-1-40-46

[19] Arakelyan MG, Bockeria LA, Vasilieva EYu, et al. 2020 Clinical guidelines for Atrial fibrillation and atrial flutter. Russian Journal of Cardiology. 2021;26(7):4594. (In Russ). doi: 10.15829/1560-4071-2021-4594

[20] Аракелян М.Г., Бокерия Л.А., Васильева Е.Ю., и др. Фибрилляция и трепетание предсердий. Клинические рекомендации 2020 // Российский кардиологический журнал. 2021. Т. 26, № 7. С. 4594. doi: 10.15829/1560-4071-2021-4594

[21] 2020 Clinical practice guidelines for Acute ST-segment elevation myocardial infarction. Russian Journal of Cardiology. 2020;25(11):4103. (In Russ). doi: 10.15829/1560-4071-2020-4103

[22] Острый инфаркт миокарда с подъемом сегмента ST электро- кардиограммы. Клинические рекомендации 2020. // Российский кардиологический журнал. 2020. Т. 25, № 11. С. 4103. doi: 10.15829/1560-4071-2020-4103

[23] Barbarash OL, Duplyakov DV, Zateischikov DA, et al. 2020 Clinical practice guidelines for Acute coronary syndrome without ST segment elevation. Russian Journal of Cardiology. 2021;26(4):4449. (In Russ). doi: 10.15829/1560-4071-2021-4449

[24] Барбараш О.Л., Дупляков Д.В., Затейщиков Д.А., и др. Острый коронарный синдром без подъема сегмента ST электрокардиограммы. Клинические рекомендации 2020 // Российский кардиологический журнал. 2021. Т. 26, № 4. С. 4449. doi: 10.15829/1560-4071-2021-4449

[25] Boldueva SA, Soloveva MV, Oblavatckii DV, et al. Myocardial Infarction in the Group of Patients With Atrial Fibrillation. Kardiologiia. 2020;60(1):53–61. (In Russ). doi: 10.18087/cardio.2020.1.n620

[26] Болдуева С.А., Соловьева М.В., Облавацкий Д.В., и др. Инфаркт миокарда у больных с фибрилляцией предсердий // Кардиология. 2020. Т. 60, № 1. С. 53–61. doi: 10.18087/cardio.2020.1.n620

[27] Tatarintseva ZG, Kosmacheva ED, Kruchinova SV, et al. Antiplatelet therapy in patients with atrial fibrillation on the background of acute coronary syndrome in real clinical practice according to the total register of acute coronary syndrome in the Krasnodar Territory. Cardiology: News, Opinions, Training. 2018;(4):6–13. (In Russ). doi: 10.24411/2309-1908-2018-14001

[28] Татаринцева З.Г., Космачева Е.Д., Кручинова С.В., и др. Антитромбоцитарная терапия у пациентов с фибрилляцией предсердий на фоне острого коронарного синдрома в реальной клинической практике (по данным тотального регистра острого коронарного синдрома по Краснодарскому краю) // Кардиология: новости, мнения, обучение. 2018. № 4 (19). С. 6–13. doi: 10.24411/2309-1908-2018-14001

[29] Soloveva MV, Boldueva SA. Antithrombotic therapy and its impact on prognosis in patients with atrial fibrillation and myocardial infarction. Long-term observation results. CardioSomatics. 2021;12(3): 158–65. (In Russ). doi: 10.26442/22217185.2021.3.201044

[30] Соловьева М.В., Болдуева С.А. Антитромботическая терапия и ее влияние на прогноз у больных с фибрилляцией предсердий, перенесших инфаркт миокарда. Данные многолетнего наблюдения // CardioСоматика. 2021. Т. 12, № 3. С. 158–165. doi: 10.26442/22217185.2021.3.201044

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